Abstract
Aims and MethodAn audit project was carried out in a mental health trust in North-West London on two successive years to determine the average case-load size of defined severe mental illness for each professional discipline.ResultsThe average case-load for non-consultants varied from 16 (for occupational therapists) through to 98 patients (for senior house officers). Community psychiatric nurses had an average case-load of 21 and consultants had an estimated average case-load of between 185 and 317 patients. The proportion of patients with severe mental illness ranged from 49% to 67%.Clinical ImplicationsThe case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, therefore, need revision.
Highlights
For some years in the UK it has been recommended that community mental health teams (CMHTs) should concentrate on seeing those with severe mental illness and to use other services, those in primary care, for those with other types of psychiatric disorder (Department of Health, 1996, 1998, 1999)
The average case-load of non-medical members of the community mental health teams in the North West London Mental Health Trust appears to be appropriate there is considerable variation between nurses in different settings
The continuous monitoring of case-load by these disciplines has probably helped to keep the numbers within manageable proportions and it seems likely that an average target of 20 patients per case-load, with approximately half having severe mental illness, is a reasonable expectation for community services
Summary
The case-loads of consultants in community health teams are too large to exercise the statutory duties of a responsible medical officer and, need revision. For some years in the UK it has been recommended that community mental health teams (CMHTs) should concentrate on seeing those with severe mental illness and to use other services, those in primary care, for those with other types of psychiatric disorder (Department of Health, 1996, 1998, 1999).
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